Data Orientation Webinar. February 16, 2016 Nikita Stempniewicz, John Cuddeback, Rich Stempniewicz, and Cori Rattelman

Transcription

1 Data Orientation Webinar February 16, 2016 Nikita Stempniewicz, John Cuddeback, Rich Stempniewicz, and Cori Rattelman

2 AGENDA Background Scope of Together 2 Goal campaign Measurement tracks Measurement periods and reporting timeline Numbers to be reported Data submission options Questions 2016 AMGF

3 TOGETHER 2 GOAL DATA SUPPORT TEAM Cindy Shekailo Director of Operations (703) ext. 361 cshekailo@amga.org Vaishali Joshi Senior Data Analyst (703) ext. 354 vjoshi@amga.org 2016 AMGF

4 BACKGROUND Based on NCQA s HEDIS 2016 Technical Specs for Physician Measurement Comprehensive Diabetes Care (CDC) Statin Therapy for Patients with Diabetes (SPD) NCQA has granted permission to use their value sets for Together 2 Goal Provided in an Excel document accompanying the specs Some differences are inevitable, mainly in constructing the denominator Together 2 Goal focuses just on patients with type 2 diabetes, while HEDIS includes all patients with diabetes mellitus. Differences between the measures for Together 2 Goal and HEDIS 2016 are described throughout the specification document. Draft measurement specifications available online Can access at: Direct link: AMGF

5 AMGA S ANCETA COLLABORATIVE Aggregate data across the continuum Clean, normalize and validate data Transform data into insight Make insights actionable Clinical claims & scheduling data Source system agnostic Automated extraction Personcentric MPI Validation Mapping NLP* Normalization Shared report library Predictive modeling Benchmarking Disease models AMGA Research Shared Learning Translation 2016 AMGF

6 USERS OF OPTUM ONE: AMGA COLLABORATIVE PARTICIPANTS

7 SCOPE OF CAMPAIGN Patients with type 2 diabetes Differs from industry-standard measures, which encompass all patients with diabetes Requires diagnosis code on a claim or specified on patients problem list in EHR Use age range from industry-standard diabetes measures: years Groups are encouraged to improve care for patients of all ages with type 2 diabetes Excluded from campaign: pregnancy Optional exclusions: polycystic ovary syndrome, gestational or steroid induced diabetes, or palliative care, hospice, or an order to discontinue diabetes treatment 2016 AMGF

8 MEASUREMENT TRACKS 2016 AMGF

9 CAMPAIGN PARTICIPANTS BY DATA REPORTING TRACK 13% 18% 16% Innovator Track TBD Basic Track Core Track 53% 2015 AMGF

10 CAMPAIGN PARTICIPANTS: CORE TRACK AHS Oklahoma Physician Group, LLC dba Utica Park Clinic Arizona Community Physicians Austin Diagnostic Clinic, P.A. Baptist Medical Group Billings Clinic Carle Physician Group Christie Clinic, LLC Colorado Springs Health Partners Community Physician Network Confluence Health The Everett Clinic Geisinger Health System Guthrie Clinic, Ltd. Hattiesburg Clinic, P.A. HealthEast Care System Henry Ford Health System Henry Ford Medical Group The Iowa Clinic, P.C. Kelsey-Seybold Clinic Lehigh Valley Health Network Lehigh Valley Physician Group Lexington Clinic, P.S.C. Mercy Clinic-East Communities Mercy Clinic-Southwest Missouri Communities Mercy Clinic-Springfield Communities Mercy Fort Smith Mercy Medical Group (CA) Mount Kisco Medical Group Mountain View Medical Group, P.C. Northeast Georgia Physicians Group Norton Medical Group Olmsted Medical Center Our Lady of the Lake Physician Group, LLC Piedmont Clinic, Inc. Piedmont HealthCare, P.A. The Polyclinic PriMed Physicians Revere Health Riverside Health System Riverside Medical Group Rockford Health Physicians Rockwood Clinic Scripps Clinic Medical Group Scripps Coastal Medical Group Sentara Medical Group Southeastern Integrated Medical Spectrum Health Medical Group SSM Health (including Dean Health Plan) ThedaCare Physicians Tulane University Medical Group Union Associated Physicians Clinic, LLC UnityPoint Clinic University of South Florida Health Watson Clinic, LLP Weill Cornell Physician Organization Westchester Health Associates Wheaton Franciscan Medical Group Wilmington Health 2015 AMGF

11 CAMPAIGN PARTICIPANTS: ADDITIONAL TRACKS BASIC TRACK Baptist Health Medical Group Bassett Healthcare Boice-Willis Clinic, P.A. Centura Health Physician Group CHRISTUS Physician Group Coastal Carolina Health Care, PA Essentia Health - Central Region Essentia Health - East Region Essentia Health - West Region Essentia Health System Signature Partners PIH Health Physicians Prevea Health Services Quincy Medical Group Riverside Medical Clinic Saint Francis Health System / Warren Clinic Sharp Community Medical Group Susquehanna Health Medical Group UMass Memorial Health Care Office of Clinical Integration/Population Health Unity Health Care INNOVATOR TRACK Austin Regional Clinic, P.A. Columbia St. Mary's Physicians - Ascension Health Cornerstone Health Care, P.A. Esse Health Harbin Clinic, LLC Horizon Family Medical Group New West Physicians, P.C. Ochsner Health System The Portland Clinic Premier Medical Associates, P.C. Sharp Rees-Stealy Medical Group, Inc. Springfield Clinic Summit Medical Group, P.A. SwedishAmerican Health System Wellmont Medical Associates Western Montana Clinic WESTMED Medical Group, P.C. TO BE DETERMINED Aurora Health Care Baptist Health Medical Group Excela Health Medical Group Franciscan Missionaries of Our Lady Health System Intermountain Healthcare Meritage Medical Network Novant Medical Group Our Lady of the Lourdes Physician Group Palo Alto Medical Foundation Park Nicollet HealthPartners Care Group St. Elizabeth Physicians (LA) St. Francis Medical Group Sutter Health University of Utah Community Clinics USMD Health System 2015 AMGF

12 MEASUREMENT PERIODS AND REPORTING TIMELINE Quarterly reporting Almost 2/3 of patients have at least one visit in last quarter of the measurement period Over 1/4 of patients have at least 2 visits in last quarter

13 OVERVIEW Values to report every quarter (7 Total) a) Active initial population Patients with at least 2 visits in an ambulatory setting with a PCP, Endocrinologist, Cardiologist, or Nephrologist b) Active initial population with type 2 diabetes (T2G cohort, denominator) Type 2 diabetes (T2G cohort, denominator) and c) HbA 1C control (measure #1) Most recent HbA 1C < 8.0% d) Blood pressure control (measure #2) Most recent BP < 140/90 e) Medical attention for nephropathy (measure #3) f) Lipid management (measure #4) Statin prescribed or had documentation of a reason not to receive a statin g) Diabetes care bundle control (measure #5) 2016 AMGF

14 OVERVIEW CONTINUED Using the numbers reported by participating organizations, Together 2 Goal and the AMGF team will calculate and track the following measures Measures to be tracked Formula Prevalence of type 2 diabetes HbA1C control Blood pressure control Medical attention for nephropathy Lipid management Diabetes care bundle 2016 AMGF

15 ACTIVE INITIAL POPULATION Patients aged with two or more face-to-face encounters During the 12 month measurement period plus the prior 6 months (18 months total) With a PCP, Endocrinologist, Cardiologist, or Nephrologist In an ambulatory setting (e.g., office visits, urgent care, and retail clinics) Two visits do not need to be with the same provider or provider specialty Used to calculate and track increases in prevalence of type 2 diabetes over time as additional patients are discovered 2016 AMGF

16 CPT/HCPCS CODES TO IDENTIFY VISITS Table 1: Codes to Identify Visits CPT/HCPCS Codes Description , Evaluation & Management Office Visit Evaluation & Management Office Consultation , Evaluation & Management Preventive Visit Preventative Medicine: Individual Counseling Visit Preventative Medicine: Group Counseling Visit 99420, Other Preventive Medicine Services G0402 Initial Preventive Physical Examination ( Welcome to Medicare Visit) G0438, G0439 Medicare Annual Wellness Visit G0463 T1015 Hospital outpatient clinic visit for assessment and management of a patient Clinic visit/encounter, all inclusive 2016 AMGF

17 EXCLUSIONS Together 2 Goal has required and optional exclusions It is up to the participating organization to determine whether there are compelling reasons to use the optional exclusions Optional exclusions will allow organizations who use these exclusions internally to reflect them in their reporting for Together 2 Goal Required exclusions Diagnosis for pregnancy (on a claim or problem list) Patient died Optional exclusions Polycystic ovary syndrome Gestational or steroid-induced diabetes Palliative care, hospice, or an order to discontinue diabetes treatment 2016 AMGF

18 DENOMINATOR Patients from active initial population with evidence for type 2 diabetes on a claim for a face-to-face visit in an ambulatory setting or the patient s problem list Codes ICD-9 ICD *0 or 250.*2, where * is any valid character E11.*, where * is any valid character string Patients with pharmacy evidence of diabetes without a diagnosis are not included many patients who have only pharmacy evidence of diabetes cannot be definitively classified as having type 2 diabetes Groups have the option to exclude patients who also have evidence of type 1 diabetes using data from organizations participating in AMGA s Anceta collaborative, ~4.7% of patients included in the campaign denominator (i.e., evidence of type 2 diabetes) also had evidence of type 1 diabetes 2016 AMGF

19 ACTIVE INITIAL POPULATION 2016 AMGF

20 PREVALENCE OF TYPE 2 DIABETES 5.03 million patients, aged 18 75, across 30 medical groups, with at least 2 visits (04/01/ /30/15) No pregnancy, polycystic ovary syndrome, or secondary diabetes (campaign exclusions) Range in prevalence of type 2 diabetes by medical group: 9.0% 18.9% 2016 AMGF

21 12 MONTHS VS. 18 MONTHS 12-month measurement period plus the prior 6 months (18 months total) 04/01/14 10/01/14 Additional 6-Month Period (visits, diagnoses, exclusions) 12-Month Measurement Period 09/30/15 Defined in the 18-month time period face-to-face encounters for inclusion in active initial population evidence of type 2 diabetes for inclusion in denominator exclusions Numerator compliance for the individual measures are almost exclusively calculated in the 12-month measurement period 2016 AMGF

22 QUARTERLY REPORTING # of Visits 04/01/14 10/01/14 Additional 6-Month Period (visits, diagnoses, exclusions) 12-Month Measurement Period 09/30/15

23 MEASURE #1 HbA 1C CONTROL Number of denominator patients whose most recent HbA 1C in the 12- month measurement period (MP) is < 8.0% this is a population threshold the target for each patient should be individualized Use last HbA 1C result in the measurement period, regardless of setting (ambulatory, urgent care, ER, inpatient, etc.) Patients with no HbA 1C measurement during the measurement period are considered to be out of control 2016 AMGF

24 2016 AMGF

25 HbA 1C CONTROL 700,000 patients, aged 18 75, across 30 medical groups, included in campaign denominator (i.e., 2 visits, no exclusions, T2DM) Overall 62% of patients included in the campaign denominator had an HbA1c < 8% Range in performance: 47% - 70%

26 HBA 1C < 7.0 VS. 8.0 VS ,000 patients, aged 18 75, across 30 medical groups, included in denominator (i.e., 2 visits, no exclusions, T2DM) Overall 19% of patients included in the campaign denominator had an HbA1c 7.0% and < 8.0% 9% of patients had an HbA1c 8.0% and < 9.0%, and 10% had an HbA1c 9.0%

27 MEASURE #2 BP CONTROL Number of denominator patients whose most recent ambulatory, inoffice blood pressure reading in the 12-month measurement period (MP) is < 140/90 mm Hg A BP measurement from an urgent care, ED, or inpatient setting may optionally be considered, but only if it is the most recent recorded BP and is < 140/90 exclude home BP readings and ambulatory BP monitoring data patients with no blood pressure recorded during the measurement period are considered to be out of control 2016 AMGF

28 2016 AMGF

29 BP CONTROL 700,000 patients, aged 18 75, across 30 medical groups, included in denominator (i.e., 2 visits, no exclusions, T2DM) Overall 72% of patients included in the campaign denominator had BP< 140/90 mm Hg Range in performance: 46% - 82%

30 MEASURE #3 MEDICAL ATTENTION FOR NEPHROPATHY Number of denominator patients who had evidence of medical attention for nephropathy during the 12-month measurement period Evidence for medical attention for nephropathy includes nephropathy screening or monitoring tests (e.g., urine protein tests) diagnosis of nephropathy or treatment for nephropathy diagnosis on a claim or problem list for nephropathy or a related condition (e.g., chronic kidney disease, end stage renal disease) visit with a nephrologist use of an angiotensin-converting-enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB) e-prescribing transaction or active on the patient s medication list in the EHR 2016 AMGF

31 2016 AMGF

32 MEDICAL ATTENTION FOR NEPHROPATHY 700,000 patients, aged 18 75, across 30 medical groups, included in denominator (i.e., 2 visits, no exclusions, T2DM) Overall 81% of patients included in the campaign denominator had medical attention for nephropathy Range in performance: 69% - 89%

33 MEASURE #4 LIPID MANAGEMENT Number of denominator patients who had a statin prescribed or had documentation of a reason not to receive a statin Statin use can be identified on e-prescribing transaction during the 12- month measurement period or on the patients medication list we accept evidence of any statin use and do not require organizations to assess the dose (different from ACC/AHA guidelines) 2016 AMGF

34 MEASURE #4 LIPID MANAGEMENT Documented reasons for not receiving a statin include In vitro fertilization, prescription for clomiphene (Clomid), cirrhosis, or ESRD Muscular pain (i.e. myalgia, myositis, myopathy, or rhabdomyolysis) Most recent low-density lipoprotein (LDL) < 70 (optional) active liver disease (e.g. hepatitis) (optional) Age < 40 and no overt cardiovascular disease (CVD) or CVD risk factors (i.e., LDL > 100, hypertension, current smoker, obese) (optional) Patients with a documented reason not to receive a statin are considered numerator compliant while it would be logical to exclude them from the denominator for the statin measure, we want to maintain the same denominator as the other three measure for the bundle measure 2016 AMGF

35 2016 AMGF

36 700,000 patients, aged 18 75, across 30 medical groups, included in denominator (i.e., 2 visits, no exclusions, T2DM) Overall 58% of patients included in the campaign denominator had evidence of statin use, 5% had no evidence of statin use but had an LDL < 70, 3% had no evidence of statin use but had a documented reason for not receiving a statin Range in performance for Lipid Management: 45% - 76% LIPID MANAGEMENT

37 MEASURE #5 BUNDLE Number of patients who were numerator-compliant for all four measures. Most recent HbA 1C < 8% (measure #1) Most recent BP < 140/90 (measure #2) Received medical attention for nephropathy (measure #3) Statin prescribed or documented reason not to prescribe a statin (measure #4) All-or-none, or bundle, measure best reflects the patient s perspective, and it encourages organizations to think of each patient as a whole and to take a system-oriented approach to improvement AMGF

38 2016 AMGF

39 BUNDLE MEASURE 700,000 patients, aged 18 75, across 30 medical groups, included in denominator (i.e., 2 visits, no exclusions, T2DM) Overall 32% were numerator compliant for the bundle measure Range in performance in statin use: 17% - 44%

40 BUNDLE MEASURE (2) Overall 34% of patients are not compliant in only 1 of the 4 measures, 20% are not compliant in 2, 10% in 3, and 4% are not compliant for all 4 measures All patients who improved in one or more of the measures would count once towards the campaign goal of 1 million patients with improved care. Only the patients in green do not have an opportunity for improvement.

41 DATA SUBMISSION OPTIONS 1. Edit and Excel template to 2. Use the campaign s data collection portal to enter or upload the data directly into a reporting interface Both methods require the participating organization and user(s) submitting data to be properly registered in the campaign database AMGF campaign staff (your regional liaisons) will facilitate the registration process Data submission can be accomplished using or the web portal interchangeably throughout the duration of the campaign

42 DATA SUBMISSION USING Data for the measures can be entered into a excel template and attached to an sent to DataForT2G@amga.org Templates appropriate to participants level of participation (Basic, Core, Innovator) will be provided to the organization or can be downloaded from the campaign portal. Participating groups will only have access to the template for their selected data reporting track. Templates are cumulative, spanning all reporting periods of the campaign timeline; to amend a submission simply edit the prior reporting period data and submit normally, the system will retain the last submission submissions must come directly from users registered with the campaign to be properly loaded into the campaign database. Please do not data submissions to campaign staff. User will receive an acknowledgement confirming a successful submission or in the case of issues, a error or warning indicator Users can login to the portal to view/edit ed submissions

43 USING THE TEMPLATE Use the template appropriate to your organizations reporting level (Basic, Core, Innovator) Template is locked permitting edits to blue fields only, all other fields are computed Template provide for cumulative data submission, no need to delete prior reporting periods, submit revisions by editing prior periods and resubmitting via , or directly edit on the portal

44 DATA SUBMISSION USING DATA PORTAL Use AMGA s data collection portal and enter the data directly into a reporting interface. AMGF campaign staff will you with credentials to access the site View/revise data previously ed for the campaign Enter/upload data directly on the portal.